title: Prophylactic implantable cardioverter defibrillator treatment in patients with end-stage heart failure awaiting heart transplantation.
abstract: OBJECTIVE
  This study was designed to delineate the role of implantable cardioverter defibrillator (ICD) therapy for the primary and secondary prevention of sudden cardiac death in patients listed for heart transplantation.
  
  
  METHODS
  Retrospective observational multicentre study.
  
  
  METHODS
  1089 consecutive patients listed for heart transplantation in two tertiary heart transplant centres were enrolled. Of 550 patients (51%) on the transplant list with an ICD, 216 had received their ICD for the primary prevention of sudden cardiac death and 334 for secondary prevention. 539 patients did not receive an ICD.
  
  
  METHODS
  Treatment with or without an ICD was left to the discretion of the heart failure specialist.
  
  
  METHODS
  All-cause mortality.
  
  
  RESULTS
  ICDs appear to be associated with a reduction in all-cause mortality in patients implanted with the device for primary and secondary prevention compared to those without an ICD despite a median time on the waiting list of only 8 months (estimated 1-year: 88±3% vs. 77±3% vs. 67±3%; p=0.0001). A Cox regressional hazard model (corrected for age, sex, underlying heart disease, atrial fibrillation, cardiac resynchronisation therapy, New York Heart Association (NYHA) class, ejection fraction, co-medication and year of listing) suggested an independent beneficial effect of ICDs that was most pronounced in patients who had received an ICD for primary prevention (HR 0.4, 95% CI 0.19 to 0.85; p=0.016).
  
  
  CONCLUSIONS
  ICD implantation appears to be associated with an immediate and sustained survival benefit for patients awaiting heart transplantation.
authors.affiliation: Cardiovascular Division, University Hospital Zurich, Raemistrasse 100, Zürich CH-8091, Switzerland.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Fröhlich
authors.forename: Johannes
authors.initials: J
authors.lastname: Holzmeister
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.forename: Samira
authors.initials: S
authors.lastname: Hübler
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolfrum
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: David
authors.initials: D
authors.lastname: Hürlimann
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lehmkuhl
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000295:instrumentation* / Q000379:methods; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000295:instrumentation* / Q000379:methods; D013557:Switzerland; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality